A biased look at psychology in the world

July 08, 2012

When People Run Amok

When Captain James Cook's journals of his extensive voyages around the world during the late 18th century, Europeans first became aware of a strange phenomenon that reporteedly occurred among the various peoples of the Malay Archipelago. Known by different names including mengamuk, pengamok, or simply amok, cases of uncontrollable violence erupting in formerly peaceful men with few, if any, warning signs continued to be reported even after Malaysia became a British territory. In one typical case from 1891, a Malay farmer named Imam Mamat suddenly erupted into violence after spending the day building a fencing around his land. After entering the house of his brother-in-law, Bilal Abu, with a spear and a golak [bladed weapon] in his hands, Mamat shook his brother-in-law's hand and asked for forgiveness. He then shook his wife's hand and asked her forgiveness as well. At that point, he immediately stabbed his wife in the abdomen with the golak. According to the report:

She immediately fell and received two more superficial wounds... Bilal Abu rushed to the rescue and received for his trouble a deep wound in the region of the heart and a superficial wound on the right side; he fell never to rise again. At this moment, Ngah Intan, wife of Bilal Abu, followed by four of her children, rushed to the door and jumped out, her eldest son Kassim receiving a stab in the back as he jumped out. Imam Mamat jumped out [the house was on stilts] and, with two more spears picked up in the house, gave chase to Ngah Intan, who was followed by her three youngest children. One little girl, Si Teh, received two wounds in the back, not dangerous ones. A boy, Mumin received a deep wound in the side and the second little girl, Si Pateh, received a severe wound in the stomach [both children later died of their injuries]. Having satisfied himself with the children, he followed up with the mother, catching her 100 yards off, and killed her on the spot by a stab in the abdomen.

Imam Mamat walked down a stream and approached a friend, Uda Majid, who attempted to stop him by asking if he knew him. Mamat replied, "Yes, but my spear doesn't know you." He then stabbed him twice in the abdomen before killing another village man who was trying to restrain him. Mamat then vanished into the jungle before attacking another family. This time, he was successfully beaten back and sustained serious injuries to his face and thigh. He died of his injuries a day later. When asked why he had become violent, witnesses reported that Mamat "did not know what he was was doing, only his head went round and the devil told him to do it." At the inquest into the deaths, fellow villagers said that the attacker was "on most friendly terms with everyone". During his rampage, he had killed six people, including two pregnant women, and wounded four others.

Although Malay cultural tradition holds that amok is caused by possession, Western psychiatrists writing about amok episodes describe it as a culture-bound syndrome most commonly found in Malaysia. Episodes of amok behaviour have also been reported in Laos, the Philippines, Polynesia (where it is known as cafard or cathard), Puerto Rico (mal de pelea), and among the Navajo (iich'aa). According to the DSM-IV-TR, amok, much like pibloktoq, koro, and ataque de nervios, is classified as a dissociative trance disorder. "Classic" symptoms found in most clinical descriptions of amok include:

assaults continuing for minutes, hours, or even days until the amok person is killed or restrained

in cases where amok sufferers survive, they typically fall into a deep sleep or stupor that can last for days

after waking, the formerly amok person continues to be withdrawn or uncommunicative and is unable to recall the violence that occurred

A less common characteristic of amok cases involves the use of bladed instruments, such as the traditional Malay short sword (known as a kris). Filipino amok cases have moved beyond the traditional edged weapons towards the use of automatic weapons (and grenades have been used during amok episodes in Laos).

Amok case studies have been reported in the clinical literature for more than a century with subjects ranging in age from early adulthood through middle age. Virtually all reported amok cases have been males with Malaysia clinicians arguing that latah (the sudden yelling of vulgar or obscene words) is the female equivalent of amok. Since there has been at least one reported case of female amok and male latah cases have also been described, the gender lines are not so easily drawn. While most amok cases were illiterate farmers or fishermen, there have also been incidents involving prosperous merchants, soldiers, skilled craftsmen, and even a member of Malaysia's royal family. In all cases where amok sufferers managed to survive and avoid prison, they were able to return to their former lives with little or no repeat violence.

What causes amok behaviour? That question has perplexed psychiatrists and medical researchers for decades. Although early psychiatrists have suggested that amok is linked to psychodynamic factors such as loss of social standing, hostility, and victim blaming, more recent investigators have described it as a behavioural syndrome with different potential causes including medical illness such as malaria or neurosyphilis. Acute intoxication has also been suggested as a possible factor in some cases (despite alcohol being forbidden in the predominantly Moslem Malay culture). Since most clinical amok cases have been diagnosed in prisons and psychiatric hospitals, it's hardly surprising that psychiatric diagnoses such as schizophrenia and bipolar disorder are commonly found in cases. Still, it is an open question whether these diagnoses can be used to explain the extreme violence in amok episodes.

Although the actual amok syndrome is less well-known, the phrase "running amok" (or "running amuck") has become part of the common language for English speakers around the world. Even in the United States, "running amok" was raised as a legal defense in the Hawaiian Supreme Court case of Orlando Ganal. Ganal, a Filipin0-American man, was charged in the shooting murders of four relatives on August 25, 1991. After killing his victimsm he then set their Honolulu house on fire. During his trial, Ganal insisted that he had "run amok" due to humiliation over his wife's infidelity which triggered his violent rampage. While the argument failed to impress the court and Ganal was sentenced to life in prison, he later attempted to appeal the decision on the grounds that the prosecutor made sarcastic remarks trivializing the amok defense. The Supreme Court rejected the argument and upheld his conviction. I am not aware of the "amok defense" being raised in any other North American criminal trial (although automatism has certainly been used in many cases).

Has amok changed over time? While cases were more frequent in Malaysia and Indonesia before English and Dutch colonialism, the advent of psychiatric treatment meant that amok episodes were increasingly more likely to be treated with lifelong incarceration in psychiatric hospitals or prisons. Even the use of the term, "amok" has changed over time. Although "classic" cases still occur, Malaysians have extended the amok term to include any episode of sudden violence happening in Malaysia (whether committed by Malays or non-Malays). Tempting as it is to use the amok label to cover episodes of "sudden murder" occurring elsewhere in the world (including the modern "spree killer" phenomenon ), there are important differences.. Although sudden violence happens throughout the world, the unique nature of amok seems to stem directly the existence of the amok tradition in local cultures.

Will amok episodes continue to occur or will they gradually fade away as seems to be happening with other culture-bound syndromes around the world? As episodes of explosive violence occur, the "running amok" explanation will likely be raised to try explaining what happened. Whether the lessons learned from dealing with amok sufferers will help with similar cases elsewhere remains to be seen.